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Maitra S, Sen S, Pal S. Combined spinal fentanyl with graded epidural anaesthesia for caesarean section in case of peripartum cardiomyopathy: A case report. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Souvik Maitra
- Department of Anaesthesiology, IPGME&R, Kolkata, India
| | - Suvadeep Sen
- Department of Anaesthesiology, IPGME&R, Kolkata, India
| | - Samarendra Pal
- Department of Anaesthesiology, MGM Medical College, Kishangunj, India
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Sood S, Kamath MR, Shetty AS. Anesthetic management of an elderly patient with kyphoscoliosis and dilated cardiomyopathy posted for abdominal hysterectomy and salpingo-oophorectomy. Saudi J Anaesth 2015; 9:464-6. [PMID: 26543469 PMCID: PMC4610096 DOI: 10.4103/1658-354x.154736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 76-year-old kyphoscoliotic female patient presented with severe pain and sudden acute abdominal distension for 1-week and was diagnosed to have right-sided massive twisted ovarian cyst. The patient was a known case of hypertension, dilated cardiomyopathy with low 20% cardiac ejection fraction. Though very few incidences of multiple co-morbid conditions existing together in a single elderly patient have been reported in the past, it is important to titrate the dosage, type of anesthetic agents and their routes of administration in high risk patients.
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Affiliation(s)
- Suvidha Sood
- Department of Anesthesiology and Critical Care, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Manjunath R Kamath
- Department of Anesthesiology and Critical Care, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Anil S Shetty
- Department of Anesthesiology and Critical Care, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
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Bajwa SK, Bajwa SJS, Sood A. Cardiac arrest in a case of undiagnosed dilated cardiomyopathy patient presenting for emergency cesarean section. Anesth Essays Res 2015; 4:115-8. [PMID: 25885243 PMCID: PMC4173346 DOI: 10.4103/0259-1162.73520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac diseases in the pregnancy pose a multitude of challenges to the obstetricians as well as anesthesiologists. Cardiac pregnant patients presenting for emergency cesarean section do not give time for cardiac optimization and stabilization if they come to the hospital for the first time without any antenatal check-up. The situation can get worse if there is no history related to the decompensated cardiac tissue with asymptomatic gestation and also if the relatives hide all the facts from the doctor about any past cardiac history. We report a case of term pregnancy for emergency cesarean section with asymptomatic dilated cardiomyopathy, which developed severe ventricular arrhythmias and cardiac arrest during the surgical procedure. She was resuscitated successfully on the operation table and was shifted to Intensive Care Unit for further management. The diagnosis of dilated cardiomyopathy was made only after carrying out echocardiography in the postoperative period. The history of previous cardiac complaints was not revealed purposefully by the relatives to avoid the expenses which they would have incurred on investigations and treatment of cardiac ailment.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Departments of Obstetrics and Gynaecology, Gian Sagar Medical College & Hospital, Ram Nagar, Banur, Punjab, India
| | - Sukhminder Jit Singh Bajwa
- Departments of Anaesthesiology & Intensive Care, Gian Sagar Medical College & Hospital, Ram Nagar, Banur, Punjab, India
| | - Ayena Sood
- Departments of Obstetrics and Gynaecology, Gian Sagar Medical College & Hospital, Ram Nagar, Banur, Punjab, India
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Ituk US, Habib AS, Polin CM, Allen TK. Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre. Can J Anaesth 2014; 62:278-88. [PMID: 25501493 DOI: 10.1007/s12630-014-0290-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period. PRINCIPAL FINDINGS Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IU·min(-1). An oxytocin infusion at a variable rate with a maximum dose of 0.05 IU·min(-1) was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IU·min(-1) after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic. CONCLUSION We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team.
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MESH Headings
- Academic Medical Centers
- Adult
- Anesthesia, Epidural
- Anesthesia, General
- Anesthesia, Obstetrical/methods
- Anesthesia, Spinal
- Cardiomyopathy, Dilated/complications
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Female
- Fetal Death
- Heart Arrest
- Humans
- Labor, Obstetric
- Outcome and Process Assessment, Health Care/statistics & numerical data
- Oxytocics/administration & dosage
- Oxytocin/administration & dosage
- Pregnancy
- Pregnancy Complications, Cardiovascular
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Affiliation(s)
- Unyime S Ituk
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA,
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Al-Aqeedi RF, Alnabti A, Al-Ani F, Dabdoob W, Abdullatef WK. Successful delivery by a cesarean section in a parturient with severe dilated cardiomyopathy, an implantable cardioverter defibrillator, and a repaired tetralogy of fallot. Heart Views 2011; 12:26-31. [PMID: 21731806 PMCID: PMC3123513 DOI: 10.4103/1995-705x.81556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Repaired congenital heart disease has become more prevalent in women of childbearing age. We report an unusual case of a 24-year-old multigravida with a repaired tetralogy of Fallot, severe dilated cardiomyopathy, and implantable cardioverter defibrillator placement who was managed successfully by a cesarean section three times. This case underscores the impact of such events on maternal and fetal safety and the importance of a multidisciplinary approach in the management of pregnant patients with complex congenital and medical problems.
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Affiliation(s)
- Rafid Fayadh Al-Aqeedi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Bhakta P, Mishra P, Bakshi A, Langer V. Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia. Yonsei Med J 2011; 52:1-12. [PMID: 21155028 PMCID: PMC3017683 DOI: 10.3349/ymj.2011.52.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
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Affiliation(s)
- Pradipta Bhakta
- Department of Anesthesiology, Sultan Quaboos University Hospital, Muscat, Sultanate of Oman
| | - Pragnyadipta Mishra
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, Fl, USA
| | - Anamika Bakshi
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
| | - Vijay Langer
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
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The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can J Cardiol 2010; 26:185-202. [PMID: 20386768 DOI: 10.1016/s0828-282x(10)70367-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world - HF in ethnic minorities - and in an uncommon but important setting - the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics - disease management programs in HF and quality assurance - have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada.
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Hsu YC, Huang ST, Ho ST, Lu CC, Lin TC, Huang GS, Liaw WJ. An unusual case of peripartum cardiomyopathy in a parturient with preeclampsia. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2010; 48:33-36. [PMID: 20434111 DOI: 10.1016/s1875-4597(10)60007-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 12/23/2009] [Accepted: 12/28/2009] [Indexed: 05/29/2023]
Abstract
Here we report an unusual development of peripartum cardiomyopathy (PPCM) in a parturient woman with preeclampsia. A 36-year-old nulliparous parturient woman underwent elective cesarean section for delivery of twins under spinal anesthesia. Both preoperative workup and past history were unremarkable except for proteinuria and hypertension for 1 week. Approximately 4 hours after cesarean section, progressive orthopnea developed. Chest plain film showed acute pulmonary edema, bilateral pulmonary infiltration with interstitial patches, and cardiomegaly. Postpartum cardiomyopathy was diagnosed afterward by echocardiography. This showed general hypokinesia and severe dysfunction of the left ventricle with ejection fraction of 15-20%. She was admitted to the intensive care unit for further management. Fortunately, the patient recovered after treatment and was discharged 15 days later. This case illustrates that we should bear in mind the possibility of PPCM if orthopnea develops while delivery is approaching in a parturient with preeclampsia. Echocardiography is helpful for early diagnosis of PPCM.
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Affiliation(s)
- Yung-Chi Hsu
- Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C
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10
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Bhakta P, Biswas BK, Banerjee B. Peripartum cardiomyopathy: review of the literature. Yonsei Med J 2007; 48:731-47. [PMID: 17963329 PMCID: PMC2628138 DOI: 10.3349/ymj.2007.48.5.731] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 07/31/2007] [Indexed: 12/31/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Clinical presentation of PPCM is similar to that of systolic heart failure from any cause, and it can sometimes be complicated by a high incidence of thromboembolism. Prior to the availability of echocardiography, diagnosis was based only on clinical findings. Recently, inclusion of echocardiography has made diagnosis of PPCM easier and more accurate. Its etiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. Prompt recognition with institution of intensive treatment by a multidisciplinary team is a prerequisite for improved outcome. Conventional treatment consists of diuretics, beta blockers, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Cardiac transplantation may be necessary in patients not responding to conventional and newer therapeutic strategies. The role of the anesthesiologist is important in perioperative and intensive care management. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover heart function. This article aims to provide a comprehensive updated review of PPCM covering etiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis, while stressing areas that require further research.
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Affiliation(s)
- Pradipta Bhakta
- Registrar, Department of Anesthesiology, Sultan Quaboos University Hospital, Muscat, Oman
| | - Binay K Biswas
- Teaching Instructor, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Basudeb Banerjee
- Professor and Head, Department of Gynecology and Obstetrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Pryn A, Bryden F, Reeve W, Young S, Patrick A, McGrady EM. Cardiomyopathy in pregnancy and caesarean section: Four case reports. Int J Obstet Anesth 2007; 16:68-73. [PMID: 17125992 DOI: 10.1016/j.ijoa.2006.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2006] [Indexed: 11/19/2022]
Abstract
We present the clinical details of four women with cardiomyopathy who required caesarean section. Two women had peripartum cardiomyopathy and two had hypertrophic obstructive cardiomyopathy, one of whom has had two caesarean sections. Those with peripartum cardiomyopathy were more compromised than those with hypertrophic obstructive cardiomyopathy. Co-operation between obstetric and cardiac anaesthetists ensured optimum experience was available. An incremental combined spinal-epidural technique with invasive monitoring was used for three women and one received general anaesthesia. The risks and benefits of different anaesthetic techniques are discussed.
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MESH Headings
- Adult
- Anesthesia, Obstetrical/methods
- Anesthesiology
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/therapy
- Cesarean Section
- Female
- Humans
- Interdisciplinary Communication
- Obstetrics
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnostic imaging
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/therapy
- Risk Factors
- Thromboembolism/prevention & control
- Ultrasonography
- United Kingdom
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Affiliation(s)
- A Pryn
- Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow, UK.
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12
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Park HY, Goo EK, Do SH, Park KS. Combined Spinal-epidural Anesthesia for Cesarean Section in a Patient with Peripartum Cardiomyopathy - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.5.605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hee Yeon Park
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyoung Goo
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hwan Do
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kum Suk Park
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
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Ray P, Murphy GJ, Shutt LE. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth 2004; 93:428-39. [PMID: 15194627 DOI: 10.1093/bja/aeh194] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Heart disease is a leading cause of maternal death. The aim of this study is to review the most common causes of cardiac disease, highlight factors that should be recognized by the clinician, and address recent advances in the anaesthetic management of these patients. Incipient cardiac disease, including peripartum cardiomyopathy, myocardial infarction and aortic dissection, accounts for approximately one in six maternal deaths. The keys to successful diagnosis and management of incipient disease are: a high index of suspicion, particularly in women with known risk factors for cardiovascular disease; a low threshold for radiological investigations; early cardiology input; and invasive monitoring during labour and delivery. Echocardiography is a safe, non-invasive test, under-used in pregnancy. Management of pregnant women with pre-existing cardiac problems should be undertaken by multidisciplinary teams in tertiary centres. In women with pre-existing cardiac disease wishing to proceed to term, cardiac status must be optimized preoperatively and planned elective delivery is preferable. Vaginal delivery is preferable, and with careful incremental regional anaesthesia is safe in most women with cardiac disease. The presence of adequate systems for early detection, appropriate referral to specialist centres, and timely delivery with multidisciplinary support can minimize the serious consequences of poorly controlled heart disease in pregnancy.
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Affiliation(s)
- P Ray
- Department of Anaesthesia, St Michaels Hospital, Bristol and Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
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Velickovic IA, Leicht CH. Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy. Int J Obstet Anesth 2004; 13:40-3. [PMID: 15321439 DOI: 10.1016/s0959-289x(03)00052-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2003] [Indexed: 11/23/2022]
Abstract
The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia in such a rare clinical situation has not been previously reported. A patient with recurrent peripartum cardiomyopathy presented in congestive heart failure for emergent cesarean section. Continuous spinal anesthesia was successfully employed as the anesthetic technique for the procedure. In addition, it also markedly reduced the patient's symptoms. Continuous spinal anesthesia is a reliable, rapidly titratable technique, which provides excellent analgesia with minimal undesirable hemodynamic changes for patients with peripartum cardiomyopathy undergoing cesarean delivery.
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Affiliation(s)
- I A Velickovic
- Department of Anesthesiology, Western Pennsylvania Hospital, Pittsburgh, PA, USA
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Velickovic IA, Leicht CH. Peripartum cardiomyopathy and cesarean section: report of two cases and literature review. Arch Gynecol Obstet 2003; 270:307-10. [PMID: 14685890 DOI: 10.1007/s00404-003-0568-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2003] [Accepted: 10/02/2003] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia with bupivacaine or combined spinal epidural anesthesia with ropivacaine in such rare clinical situations has not been previously reported. CASE REPORT We present two cases in which parturients with the diagnosis of peripartum cardiomyopathy presented in congestive heart failure for emergent Cesarean section. Continuous spinal anesthesia and combined spinal-epidural anesthesia were successfully employed as the anesthetic techniques for the procedures. Both patients remained hemodynamically stable during surgery and were discharged home on postoperative days 5 and 4 respectively.
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Affiliation(s)
- Ivan A Velickovic
- Department of Anesthesiology, Western Pennsylvania Hospital, 4800 Friendship Avenue, MP Suite 459, Pittsburgh, PA 15224, USA
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Naidoo DP, Moodley J. Management of the critically ill cardiac patient. Best Pract Res Clin Obstet Gynaecol 2001; 15:523-44. [PMID: 11478813 DOI: 10.1053/beog.2001.0198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The decline in rheumatic fever has made heart disease in pregnancy an uncommon problem in the developed world but it remains an important cause of maternal morbidity and mortality in developing countries. Pregnancy is particularly dangerous in the presence of cyanotic congenital heart disease, Eisenmenger's syndrome, primary pulmonary hypertension, Marfan's syndrome, dilated cardiomyopathy and significant mitral stenosis. Severe stenosis is often complicated by pulmonary hypertension and atrial fibrillation. Maternal disease status should be determined using echocardiography to define cardiac anatomy, assess ventricular function and estimate intracardiac pressure gradients. Patients in the New York Heart Association functional classes 1 and 2 generally have a favourable outcome. Closed mitral commissurotomy is safe and effective in relieving stenosis across the mitral valve in selected patients. More recently the technique of percutaneous balloon mitral valvotomy has successfully been used in the treatment of mitral stenosis. Termination of pregnancy is advised in patients with severe pulmonary hypertension, including Eisenmenger's syndrome.
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Affiliation(s)
- D P Naidoo
- Cardiac Unit, Department of Medicine, King Edward VII Hospital, The Medical School, Durban, Natal, South Africa
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Pirlet M, Baird M, Pryn S, Jones-Ritson M, Kinsella SM. Low dose combined spinal-epidural anaesthesia for caesarean section in a patient with peripartum cardiomyopathy. Int J Obstet Anesth 2000; 9:189-92. [PMID: 15321091 DOI: 10.1054/ijoa.1999.0374] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient with peripartum cardiomyopathy was scheduled for elective caesarean section after stabilization on medical therapy. Wer performed a combined spinal epidural using one ml 0.5% hyperbaric bupivacaine (5 mg) with 0.3 mg diamorphine for the spinal. The epidural was topped up with 10 mL bupivacaine 0.5%. Significant haemodynamic changes consisted of reduction in heart rate and hypotension after the spinal, and tachycardia after delivery. The benefits and risks of this approach are discussed.
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Affiliation(s)
- M Pirlet
- Sir Humphry Davy Department of Anaesthesia, St Michael's Hospital, Bristol, UK
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Abstract
PURPOSE To describe the clinical course and management of a patient who presented with idiopathic dilated cardiomyopathy in early pregnancy. CLINICAL FEATURES A 27 yr old, previously well, Chinese primigravida presented at 18 wk gestation with a history of irregular heart beat and decreased exercise tolerance. Echocardiography showed moderate left ventricular dysfunction with left ventricular ejection fraction of 35-40%. Idiopathic dilated cardiomyopathy was diagnosed. She declined termination of pregnancy and was managed medically with furosemide, digoxin and potassium supplements. Low molecular weight heparin was prescribed. Emergency Cesarean delivery was performed at 31 wk gestation because of deteriorating liver function and a non-reassuring fetal heart rate pattern. General anesthesia was given because of relative urgency, the patient's wish, and concerns about potential risk of spinal hematoma. Invasive monitoring with pulmonary and radial artery catheters was used and low dose inotropic support was given. Postoperatively, she was managed in the intensive care and coronary care units where she was treated with dobutamine, furosemide, digoxin, potassium, captopril, losartin and warfarin. Her postoperative course was complicated by a severe embolic stroke five weeks after delivery and she died five months later. CONCLUSION Idiopathic dilated cardiomyopathy may rarely present in pregnancy. A multidisciplinary approach and close peripartum monitoring are important in management and termination of pregnancy should be considered. Thromboembolic complications are a major risk.
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Affiliation(s)
- F Chan
- Department of Anaesthesia & Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
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Heider AL, Kuller JA, Strauss RA, Wells SR. Peripartum cardiomyopathy: a review of the literature. Obstet Gynecol Surv 1999; 54:526-31. [PMID: 10434273 DOI: 10.1097/00006254-199908000-00023] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Peripartum cardiomyopathy (PPCM) is a poorly characterized, rare form of cardiomyopathy. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The presentation is similar to other forms of congestive heart failure; the diagnosis of PPCM should not be considered until other causes of cardiac dysfunction are ruled out. Echocardiography is central to diagnosis. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Intensivists and anesthesiologists should be consulted to assist with management in complicated cases. Management of PPCM is essentially supportive. Prognosis is poor, although cardiac transplant is improving prognosis and should be considered when conventional therapy fails. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completion of this article, the reader will be able to understand the typical presentation of peripartum cardiomyopathy including adverse outcome predictors, to understand how to make the diagnosis of PPCM and how to manage it, and to understand the natural history of the disease.
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Affiliation(s)
- A L Heider
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, 27599-7570 USA
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